Under a previous contract, Health Accounting was shown to be a desirable and practical method by which patient health outcomes can be the focus for quality of care assessment. The intent of this previous work was to develop, implement, and evaluate Health Accounting in multi-specialty group practice settings. As a continuation of these studies, this grant was sought to measure the organizational impact of Health Accounting as a system and the reliability and validity of its major procedures. Specific grant objectives include: 1) consolidation and analysis of previous Health Accounting experiences and development of new project resources; 2) evaluation of the reliability and validity of the basic procedures of the Health Accounting method; 3) examination of the impact of Health Accounting on patient health; and 4) evaluation of the impact of Health Accounting on clinic organization and administration. The work was continued in several multi-speciality group practice settings located across the nation.